Purpose of Study Up to 35% of asthmatic children have degrees of sleep disordered breathing (SDB) which may be perceived as uncontrolled asthma. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines and include nighttime awakenings as one asthma impairment category. Unclear whether this stems from asthma or SDB. The Pediatric Sleep Questionnaire (PSQ) is validated to identify SDB in children; however associations with specific levels of NAEPP guideline's asthma related impairment have not been evaluated. We hypothesize that asthmatic children with impairment only in NAEPP nighttime awakenings, but not other categories, will have a positive PSQ score (>0.33), suggesting screening for SDB.
Methods Used We performed a retrospective chart review of children (age 1–21 yrs) referred to a pediatric pulmonary clinic. Data collected included age, gender, BMI%, spirometry, PSQ, asthma control (TRACK <5 yrs, ACT ≥5 yrs), and NAEPP asthma severity, control and impairment. Significant PSQ scoring is >0.33 based on previous validation. Spirometry was performed in children ≥5 yrs. Statistical analysis performed with SPSS 22.
Summary of Results 76 inner-city children were included in this study; 38% female, mean age 6.9 y, and mean BMI% 69%. Significant PSQ scoring (>0.33 vs ≤0.33) was associated with night time awakenings (OR 11.4 [95% CI:3.7–35.2]) and decreased asthma control seen in TRACK (p<0.003) and ACT questionnaires (p<0.001). Overweight/obese status (BMI% ≥85), spirometry, asthma severity, activity interference and daytime symptoms were not associated with a significant PSQ score.
Conclusions In asthmatic children, impairment in night time awakenings as defined by NAEPP guidelines was associated with a significant PSQ score, and poor asthma control, based on abnormal TRACK and ACT scores, however other NAEPP categories of impairment; daytime symptoms, activity interference, asthma severity and control, were not. This suggests that screening SDB with the PSQ in children with night time awakenings based on NAEPP criteria may detect underlying SDB. This may lead to further investigations, treatment and subsequent improvement in asthma symptoms. A prospective analysis in a larger cohort is recommended to validate these findings.
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